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STATE OF LOUISIANA DEPARTMENT OF JUSTICE CRIMINAL DIVISION

STATE OF LOUISIANA DEPARTMENT OF JUSTICE CRIMINAL DIVISION. IDENTIFYING & ADDRESSING MEDICAID FRAUD and RESIDENT ABUSE. MEDICAID FRAUD CONTROL UNIT. Post Office Box 94005 Baton Rouge, Louisiana 70804-9005 Telephone: (225) 326-6210 Fax: (225) 326-6295. CHARLES C. FOTI, JR.

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STATE OF LOUISIANA DEPARTMENT OF JUSTICE CRIMINAL DIVISION

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  1. STATE OF LOUISIANA DEPARTMENT OF JUSTICE CRIMINAL DIVISION IDENTIFYING &ADDRESSING MEDICAID FRAUD and RESIDENT ABUSE MEDICAID FRAUD CONTROL UNIT Post Office Box 94005 Baton Rouge, Louisiana 70804-9005 Telephone: (225) 326-6210 Fax: (225) 326-6295 CHARLES C. FOTI, JR. ATTORNEY GENERAL

  2. MEDICAID IS FOR THE NEEDY -- NOT THE GREEDY!

  3. FRAUD “An intentionaldeception or misrepresentation which an individual or entity makes, knowing that the deception could result in some unauthorized benefit to another.” • U.S. HEALTH EXPENDITURES, FY 2006-07 • 1 TRILLION • $100 BILLION FRAUDULENT, PER YEAR • LOUISIANA MEDICAID EXPENDITURES • FY 2006-07 • Approximately $6.5 BILLION • 650 MILLION FRAUDULENT • THIS YEAR!!!

  4. YES, WE ARE SERIOUS! So far this year: Over 100 cases have been opened for investigation 30 arrests! 18 convictions! (the remainder are awaiting trial) More cases are reported and investigated EVERY DAY!

  5. MEDICAID FRAUD (La. R.S. 14:70.1) A. The crime of Medicaid fraud is the act of any person, who, with intent to defraud the state through any medical assistance program created under the federal Social Security Act and administered by the Department of Health and Hospitals: (1) Presents for allowance or payment any false or fraudulent claim for furnishing services or merchandise; or (2) Knowingly submits false information for the purpose of obtaining greater compensation than that to which he is legally entitled for furnishing services or merchandise;

  6. MEDICAID FRAUD (continued) B. Whoever commits the crime of Medicaid fraud shall be imprisoned, with or without hard labor, for not more than five (5) years, or may be fined not more than twenty thousand dollars ($20,000), or both.

  7. CRUELTY TO THE INFIRMED (La. R.S. 14:93.3) A. Cruelty to the infirmed is the intentional or criminally negligentmistreatmentor neglect by any person, including a caregiver, whereby unjustifiable pain, malnourishment, or suffering is causedtothe infirmed, a disabled adult, or an aged person, including but not limited to a person who is aresident of a nursing home, mental retardation facility, mental health facility, hospital, or other residential facility. E.Whoever commits the crime of cruelty to the infirmed … shall be fined not more than ten thousand dollars ($10,000) or imprisoned with or without hard labor for not more than ten (10) years, or both.

  8. EXPLOITATION OF THE INFIRMED (La. R.S. 14:93.4) A. Exploitation of the infirmed is: (1) Theintentional expenditure, diminution, or useby any person, including a caregiver, of the property or assetsof the infirmed, a disabled adult, or an aged person, including, but not limited to aresident of a nursing home,mental retardation facility, mental health facility, hospital, or other residential facilitywithout the express, voluntary consentof the resident or the consent of a legally authorized representative of an incompetent resident,or by means of fraudulent conduct, practices, or representations. E.Whoever commits the crime of exploitation of the infirmed shall be fined not more than ten thousand dollars ($10,000) or imprisoned with or without hard labor for not more than ten (10) years, or both.

  9. FALSE STATEMENTS CONCERNING EMPLOYMENT IN A NURSING OR HEALTH CARE FACILITY (La. R.S. 14:126.3) A. The crime of health care facility application fraud is theknowing and intentional offering of a false written or oral statement in any employment application or in an effort to obtain employment as acaretakerin any nursing home, mental retardation facility, mental health facility, hospital, home health agency, hospice, or other residential facility required to be licensed or operated under the laws of this state or established by the laws of this state. Such false statement must berelevant to the caretaking obligationof such employee, but shall specifically apply to but nor be limited to educational and professional background and licensing and credential qualifications. B. Any person who violates the provisions of this Section shall be fined not more than five hundred dollars ($500) or imprisoned for not more than six (6) months, or both.

  10. FILING FALSE PUBLIC RECORDS (La. R.S. 14:133) A. Filing false public records is the filing or depositing for record in any public office or with any public official, or the maintaining as required by law, regulation, or rule, with knowledge of its falsity, of any of the following: (1) Any forged document; (2) Any wrongfully altered document; (3)Any document containing a false statement or false representation of a material fact. C. Whoever commits the crime of filing false public records shall be imprisoned for not more than five (5) years with or without hard labor, or shall be fined not more thanfive thousand dollars ($5000), or both.

  11. DUTY TO MAKE COMPLAINTS (La. R.S. 40:2009.20) B. (1) Any person who is engaged in the practice of medicine, social services, facility administration, psychological or psychiatric services; or any registered nurse, licensed practical nurse, nurse’s aide, personal care attendant, respite worker, physician’s assistant, physical therapist, or any direct caregiver having knowledge that a consumer’s physical or mental health or welfare has been or may be further adversely affected by abuse, neglect, or exploitation shall, within twenty-four (24) hours, submit a report to thedepartment, or inform theunit, orlocal law enforcement agencyof such abuse or neglect. When the department receives a report of sexual or physical abuse, whether directly or by referral, the department shall notify the chief law enforcement agency of the parish in which the incident occurred of such report. Such notification shall be made prior to the end of the business day subsequent to the day on which the department received the report. For the purposes of this Paragraph, the chief law enforcement agency of Orleans Parish shall be the New Orleans Police Department.

  12. DUTY TO MAKE COMPLAINTS (La. R.S. 40:2009.20), Continued (2)Any person who knowingly or willfully violates the provisions of this Section shall be fined not more than five hundred dollars ($500) or imprisoned for not more than two (2) months, or both. C. Any person, other than the person alleged to be responsible for the abuse or neglect, reporting pursuant to this Section in good faith shall have immunity from any civil liabilitythat might otherwise be incurred or imposed because of such report. Such immunity shall extend to participation in any judicial proceeding resulting from such report.

  13. CONSEQUENCES OF COMMITTING ABUSE: IMMEDIATE TERMINATION ARREST AND PROSECUTION MAXIMUM CRIMINAL PENALTIES OF 10 YEARS IN PRISON AND A $10,000 FINE LOSS OF CERTIFICATION (LPN’s, RN’s, CNA's) MEDICAID EXCLUSION MINIMUM 5 YEARS

  14. TO REPORT ABUSE, CONTACT: ATTORNEY GENERAL’S MEDICAID FRAUD CONTROL UNIT 1-888-799-6885 (REPORTS MAY ALSO BE MADE TO THE LOUISIANA DEPARTMENT OF HEALTH & HOSPITALS (DHH), LOCAL POLICE, OR THE SHERIFF’S OFFICE.)

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